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BCBS/Anthem Coding Exclusions

We are receiving denials for multiple clinics in different states from Blue Cross Blue Shield and Anthem carriers with coding exclusions. Some policies are rejecting claims with diagnosis code combinations that are no longer allowed per Blue Cross Blue Shield/Anthem. We do not have an entire list of the codes at this point nor are we able to pull an official policy regarding these denials.
What we do know……
  • Claims are rejecting on EOB’s
  • As we find these accounts, we are notifying you on your Missing Info List – and asking you to update the codes
  • Once updated by you – we are then re-billing the claims
  • There will be a delay in reimbursement
Some of the codes affected:
M54.2   CANNOT be billed with any of the M50 series codes
M54.6   CANNOT be billed with any of the M51 series codes
This is a global issue we are working on and are notifying the clinics affected ASAP. If you’ve been notified please be sure to get your accounts updated as quickly as possible! If you have not been notified separately, please consider this informational only at this time.

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